Complications of FGM

Short term complications

Haemorrhage

Haemorrhage is one of the most common complications of FGM, as excision of the clitoris involves cutting across the high pressure clitoral artery and attempts to stop bleeding may not be effective. Acute extensive bleeding can lead to haemorrhagic shock or even sudden death in the case of cataclysmic haemorrhage.

Shock

Shock may occur because of blood loss and the severe pain and trauma of the procedure. Both haemorrhagic and neurogenic shock can be fatal.

Pain

The majority of mutilation procedures are performed without anaesthetics and cause the girl severe pain. Even if a local anaesthetic is used, multiple insertions of the needle are often required.

Urinary retention

Urinary Retention is very common and may last for hours or days. It is commonly due to pain, tissue swelling, inflammation, injury to the urethra, and fear of passing urine on the raw wound.

Injury to adjacent tissue

Injury to the urethra, vagina, perineum and rectum can result from the use of crude instruments, poor light, careless techniques, or from the struggles of the girl.

Infection

Infection commonly occurs for a number of reasons; unhygenic conditions, the use of unsterilized instruments, applications of traditional herbs or ashes to the wound, contamination of the wound with urine and/or faeces, or binding of the legs following infibulation which prevents wound drainage. Septicaemia and tetanus may also develop.

Fracture or dislocation

Fracture of the clavicle, femur, humerus or hip joint can occur if heavy pressure is applied to a struggling girl during the procedure - as often occurs when several adults hold her down.

Failure to heal

Wounds may fail to heal quickly because of infection, irritation from urine, underlying anaemia or malnutrition.

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Long term complications

Difficulties with micturition

Difficulties can occur due to damage to the urethral opening, obstruction of the urinary opening, or scarring of the meatus - and can lead to chronic incontinence or difficulty passing urine. For many infibulated girls, passing urine can take up to 20 minutes when they are still virgins.

Recurrent urinary tract infections (UTIS)

Partial occlusion of the vagina and urethra means the normal flow of urine is deflected and the perineum remains constantly wet and susceptible to bacterial growth. Retrograde UTI's therefore commonly occur, affecting the bladder, uterus and kidneys. Damage to the lower urinary tract during the procedure can also result in urinary tract infections.

Chronic pelvic infections

Partial occlusion of the vagina and urethra increases the likelihood of infection and ascending pelvic infections are common. The infections are often painful and may be accompanied by a noxious discharge spreading to the uterus, fallopian tubes and ovaries - and frequently become chronic.

Infertility

Infertility can occur due to chronic pelvic infections causing irreparable damage to the reproductive organs.

Vulvul abscesses

Vulval abscesses develop due to deep infection resulting from faulty healing or an embedded stitch causing the formation of an abscess.

Neurinoma

Neurinoma can develop when the dorsal nerve of the clitoris is cut or trapped in a stitch or in scar tissue. The surrounding area becomes hypersensitive and unbearably painful.

Keloid scars

Keloid scars result from slow and incomplete healing of the wound and the production of excess scar tissue. The scars may obstruct the vaginal opening and be so extensive that they prevent penile penetration.

Dermoid cysts

Dermoid cysts result from inclusion of the epithelium during healing, leading to swelling or pockets producing secretion. The cysts vary in size, are extremely painful and can prevent sexual intercourse.

Calculus formation

Calculus formation develop due to menstrual debris or urinary deposits in the vagina or in the space behind the bridge of the scar tissue.

Fistulae

Vesico-vaginal or recto-vaginal fistulae can form as a result of injury during circumcision, de-infibulation, re-infibulation, sexual intercourse, or obstructed labour. Urinary and faecal incontinence may be lifelong with severe social consequences.

Difficulties with menstruation

Partial or total occlusion of the vaginal opening commonly results in dysmenorrhoea or amenorrhea. Haematocolpos occasionally occurs from the retention of menstrual blood due to the almost complete coalescence of the labia.

Increased risk of HIV transmission

There is an increased risk of HIV transmission due to the use of the same unsterile instruments in-group circumcisions, repeated cutting and stitching during labour, and the higher incidence of lacerations and abrasions during intercourse.

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Sexual complications

Many women who have undergone FGM experience various forms and degrees of sexual aberrations. These may include fear associated with initial sexual intercourse, pain associated with sexual intercourse, difficulty or inability to have sexual intercourse, vaginismus, and decreased sexual pleasure and fulfilment. It is difficult to assess the impact of FGM on women's sexual fulfilment however, as each individual woman with FGM will be affected differently. Factors such as the type of FGM and the amount of tissue removed, the extent of scarring, the experience of the initial procedure, cultural and social expectations, and affection and bonding in sexual relationships will all impact directly on sexuality and sexual functioning.

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Childbirth complications

There are a range of childbirth complications that can be associated with FGM, particularly with Type 3 FGM (infibulation). The extent of the complications varies depending on factors such as the type of FGM, parity, and the nature of the scar tissue. Complications that can occur following infibulation, particularly amongst primigravidas, are as follows:

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Psychosocial complications

There is very limited research on the impact of FGM on psychological health. The research that has been conducted is sparse and as FGM is condoned in many of the countries where it is practiced, research is likely to have been limited by social and cultural restrictions on the exploration of any negative impacts of the practice.

Some of the negative psychological effects that have been reported include feelings of anxiety, fear, bitterness and betrayal, loss of trust, suppression of feelings, feelings of incompleteness, loss of self esteem, panic disorders and difficulty with body image. When considering the psychosocial consequences of FGM, it is important to balance the traumatic impact of the initial FGM procedure and its long-term sequelae, against the social and cultural benefits that FGM brings to young girls in the communities where it is practiced.

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See Recommended Reading for references, additional information and recommended links.